Early medical abortion (EMA) or ‘the abortion pill’ is an option in the first nine to 10 weeks of pregnancy (depends on the provider). It's offered at hospitals, community clinics, and some Sexual Wellbeing Aotearoa clinics. It can be arranged over the phone with some abortion providers. In most cases, the pregnancy passes at home.
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The following information is a guide only. The procedure can vary between clinics.
The procedure
To have an early medical abortion you have to take two medicines (tablets). The first medicine, mifepristone, blocks the hormone that is necessary for the pregnancy to continue. The second medicine, called misoprostol, causes the pregnancy to pass (miscarry).
- To start the abortion, you'll take the first medicine. This can be with the nurse, doctor or midwife at a clinic or doctor’s office, or you can take it at home.
- Very rarely, some people pass the pregnancy tissue after the first medicine (mifepristone). If this happens, you should contact your abortion provider for advice.
- 24 to 48 hours later you take the second medicine (misoprostol). You will take it at home or a place you feel comfortable.
- Discuss with the nurse, doctor or midwife what times to take the medicines to fit in with your day.
- Have a support person/tangata tautoko with you and access to a telephone and transport in case you need advice or help.
- Have a supply of pain relief and sanitary pads. Your abortion provider will discuss pain relief with you and when it's best to take it.
Using DECIDE's early medical abortion (EMA) by phone service?
What to expect during an early medical abortion
- Bleeding should start within a few hours after you take the second medicine (misoprostol). You'll get stomach pain and cramps which might be quite strong. The amount of bleeding and cramping varies from person to person. There are usually strong cramps during the miscarriage itself (as the pregnancy passes).
- Usually, the bleeding is bright red and heavy with some clots. In the first few hours, along with clots, you might pass some tissue that is paler in colour into your sanitary pad. You might see the pregnancy sac, which is white and fluffy with reddish/brown tissue surrounding it.
- In some cases, the bleeding can be very heavy and a few people might need medication or a surgical procedure to stop the bleeding and/or a blood transfusion (this is very rare).
- Possible side effects of the medicines can be diarrhoea (runny poo), nausea (sickness), headache, dizziness, hot flushes and chills (feeling cold).
- Gradually the bleeding gets lighter and might turn darker brownish. You might continue to have some bleeding for up to two weeks. If it's more than that contact your abortion provider.
EXPECTED UNEXPECTED - Bleeding like a period, light or spotting, stop/start for up to two weeks.
- Mild to strong cramps (relieved with regular pain relief).
- (For medical abortion) passing a few large blood clots, for up to 10 days.
- Very heavy bleeding, soaking two full-sized sanitary pads an hour for two hours in a row or passing lots of large clots, or a clot the size of your fist.
- Uncontrollable or constant pain.
- Pain in your shoulder tip.
- Vomiting (throwing up) after taking medications.
- Fever or feeling unwell.
- Smelly vaginal discharge.
- Bleeding, lasting more than three weeks.
Contact your abortion provider if you are experiencing any of these symptoms.
Pregnancy remains
- Talk to your abortion provider about what to do with the pregnancy remains (foetal tissue or ’products of conception’).
- You can sit on the toilet while passing the pregnancy tissue or wear sanitary pads. If you wear pads you can collect the pregnancy tissue. You might choose to bury the pregnancy remains, returning the tissue and wairua to the whenua. You can talk about other options with your abortion provider.
Taking care of yourself
Your abortion provider will give you instructions about how to care for yourself during the procedure and how to get care if you have any complications.
Everyone experiences discomfort and pain differently. Some ways to reduce discomfort:
- Be in a familiar, relaxing place.
- Have supportive people with you.
- Do activities that you enjoy (avoid strenuous exercise or stressful activities).
- You or your whānau might choose rongoā rākau and te oo mai reia for post abortion relief.
Discomfort and pain may be reduced by:
- Taking deep relaxing breaths.
- Using a hot water bottle or heat pack.
- Taking any prescribed medicines as directed, including pain relief.
Be kind to yourself. Listen to your body and ask for advice or help at any time if you need it.
How to know if the procedure has worked
- Bleeding and cramping is a good sign the abortion has worked, however, it is not proof that the abortion is successful.
- To be certain you are no longer pregnant you need to have a blood test five to seven days after taking the medicines. Your abortion provider will arrange this test.
- Generally, a medical abortion is between 90 and 99% successful (depending on how many weeks pregnant you are). If the procedure does not work, you might be referred for a surgical abortion.
Breastfeeding and medicines used in EMA: possible side-effects
Two medicines (tablets), mifepristone and misoprostol, are taken when you have an early medical abortion (EMA).
When you take mifepristone, small amounts are passed through your breast milk. There are no known negative effects from this and you can continue to breastfeed as usual.
When you take misoprostol, small amounts of misoprostol are passed through your breast milk. These are not harmful but can cause the baby to have runny poos (diarrhoea), tummy (abdominal) cramps and be a little grumpy (irritable).
You can:
- Continue breastfeeding as usual. You may notice some of the side-effects mentioned above.
- Plan the timing of misoprostol tablets around breastfeeds. For example, feed your baby, take the misoprostol tablets immediately afterwards, then plan the next feed for 3-4 hours later.
- Express and discard breast milk for 3-6 hours after taking misoprostol.
If you're worried about side-effects of any of the medicines you're given for your EMA, contact your abortion provider, your GP, or your after-hours medical centre.